Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019
Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019
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DOI：
10.1001/jamanetworkopen.2020.3976
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发表时间：
2020-03-23
影响因子：
13.8
通讯作者：
Hu, Shaohua
中科院分区：
文献类型：
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作者：
Lai, Jianbo;Ma, Simeng;Hu, Shaohua
接触2019冠状病毒病（COVID-19）的医护人员可能会受到心理压力。目的评估中国医护人员治疗COVID-19暴露患者的心理健康结局程度及其相关因素。这项横断面、基于调查的地区分层研究收集了2020年1月29日至2020年2月3日期间中国34家医院1257名卫生保健工作者的人口统计数据和心理健康测量数据。在配备发烧门诊或COVID-19患者病房的医院工作的医护人员符合条件。抑郁、焦虑、失眠和苦恼的症状程度分别采用中文版的9项患者健康问卷、7项广泛性焦虑障碍量表、7项失眠严重程度指数和22项事件影响量表进行评估。进行多变量logistic回归分析以确定与心理健康结果相关的因素。结果1830名接触者中1257人完成调查，参与率为68.7%。26 ~ 40岁813例（64.7%），女性964例（76.7%）。在所有参与者中，764名（60.8%）是护士，493名（39.2%）是医生；武汉市医院工作人员760人（占60.5%），一线医护人员522人（占41.5%）。相当比例的参与者报告了抑郁（634人[50.4%]）、焦虑（560人[44.6%]）、失眠（427人[34.0%]）和痛苦（899人[71.5%]）的症状。护士、女性、一线医护人员和在中国武汉工作的医护人员报告的所有心理健康症状的严重程度均高于其他医护人员(例如，医生和护士的患者健康问卷得分中位数：4.0[1.0-7.0]比5.0 [2.0-8.0],P = .007；男性和女性的广泛性焦虑量表得分中位数[四分位数范围{IQR}]: 2.0[0-6.0]比4.0 [1.0-7.0],P < .001；一线与二线员工失眠严重指数中位数：6.0 [2.0-11.0]vs 4.0 [1.0-8.0]；P < .001；事件量表-武汉地区与湖北以外地区、湖北以外地区的影响中位数[IQR]: 21.0[8.5-34.5]对湖北以外地区18.0[6.0-28.0]，湖北以外地区15.0 [4.0-26.0]；P < 0.001)。多变量logistic回归分析显示，与武汉受试者相比，来自湖北以外地区的受试者出现困扰症状的风险较低（优势比[OR]， 0.62; 95% CI, 0.43-0.88; P = 0.008）。直接参与COVID-19患者诊断、治疗和护理的一线医护人员出现抑郁（OR, 1.52; 95% CI, 1.11-2.09; P = 0.01）、焦虑（OR, 1.57; 95% CI, 1.22-2.02; P < 0.001）、失眠（OR, 2.97; 95% CI, 1.92-4.60; P < 0.001）和痛苦（OR, 1.60; 95% CI, 1.25-2.04; P < 0.001）等症状的风险较高。结论与意义在本次调查中，在武汉及中国其他地区设有新冠肺炎发热门诊或病房的医院的医护人员中，参与者报告了心理负担，特别是护士、妇女、武汉地区的医护人员以及直接从事新冠肺炎诊断、治疗和护理的一线医护人员。本横断面研究评估了中国治疗冠状病毒病2019 （COVID-19）患者的医护人员心理健康后果的严重程度和相关因素。在中国，哪些因素与治疗2019冠状病毒病（COVID-19）患者的医护人员的心理健康结果相关？在对中国多个地区34家设有新冠肺炎发热门诊或病房的1257名医护人员进行的横断面研究中，相当比例的医护人员报告出现抑郁、焦虑、失眠和痛苦症状，尤其是女性、护士、武汉地区的医护人员以及直接从事新冠肺炎疑似或确诊患者诊断、治疗或护理的一线医护人员。这些发现表明，在接触COVID-19的中国医护人员中，女性、护士、武汉医护人员和一线医护人员出现不利心理健康结果的风险很高，可能需要心理支持或干预。
Importance Health care workers exposed to coronavirus disease 2019 (COVID-19) could be psychologically stressed. Objective To assess the magnitude of mental health outcomes and associated factors among health care workers treating patients exposed to COVID-19 in China. Design, Settings, and Participants This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from 1257 health care workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China. Health care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 were eligible. Main Outcomes and Measures The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the 22-item Impact of Event Scale-Revised, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes. Results A total of 1257 of 1830 contacted individuals completed the survey, with a participation rate of 68.7%. A total of 813 (64.7%) were aged 26 to 40 years, and 964 (76.7%) were women. Of all participants, 764 (60.8%) were nurses, and 493 (39.2%) were physicians; 760 (60.5%) worked in hospitals in Wuhan, and 522 (41.5%) were frontline health care workers. A considerable proportion of participants reported symptoms of depression (634 [50.4%]), anxiety (560 [44.6%]), insomnia (427 [34.0%]), and distress (899 [71.5%]). Nurses, women, frontline health care workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other health care workers (eg, median [IQR] Patient Health Questionnaire scores among physicians vs nurses: 4.0 [1.0-7.0] vs 5.0 [2.0-8.0]; P = .007; median [interquartile range {IQR}] Generalized Anxiety Disorder scale scores among men vs women: 2.0 [0-6.0] vs 4.0 [1.0-7.0]; P < .001; median [IQR] Insomnia Severity Index scores among frontline vs second-line workers: 6.0 [2.0-11.0] vs 4.0 [1.0-8.0]; P < .001; median [IQR] Impact of Event Scale-Revised scores among those in Wuhan vs those in Hubei outside Wuhan and those outside Hubei: 21.0 [8.5-34.5] vs 18.0 [6.0-28.0] in Hubei outside Wuhan and 15.0 [4.0-26.0] outside Hubei; P < .001). Multivariable logistic regression analysis showed participants from outside Hubei province were associated with lower risk of experiencing symptoms of distress compared with those in Wuhan (odds ratio [OR], 0.62; 95% CI, 0.43-0.88; P = .008). Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 were associated with a higher risk of symptoms of depression (OR, 1.52; 95% CI, 1.11-2.09; P = .01), anxiety (OR, 1.57; 95% CI, 1.22-2.02; P < .001), insomnia (OR, 2.97; 95% CI, 1.92-4.60; P < .001), and distress (OR, 1.60; 95% CI, 1.25-2.04; P < .001). Conclusions and Relevance In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19.This cross-sectional study assesses the magnitude of mental health consequences and associated factors among health care workers treating patients exposed to coronavirus disease 2019 (COVID-19) in China.Question What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease 2019 (COVID-19)? Findings In this cross-sectional study of 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in multiple regions of China, a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. Meaning These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.